Pump Works
by LegalEagleFeathers
Summary: Bowser's friends start to notice he doesn't feel very well; he's drinking a lot of water and can't see clearly. Will he be okay? Only Dr. Toad and Nurse Koopetta know.


"Gwahahahaha!"

Bowser cackled as he ran to his newest little flying vehicle and jumped in, carrying Peach on his shoulder.

"Mario! Luigi! Help me!"

Peach cried as Bowser flew away to his castle.

On the way, Peach noticed empty water bottles littering the floor of the flying contraption, and asked Bowser about it. She noticed he was shifting from leg to leg a little bit as the copter went faster. Upon landing, he had his Paratroopas take care of imprisoning Peach as he ran off and returned a few minutes later.

"Let me go! Please!" Peach said angrily, until the Paratroopas had seated her at a table with plenty of food on it and Bowser just getting comfortable.

"You better not have had lunch yet, the Chef Guys made a bunch of stuff, 'cause you're gonna be stuck here a while! Gwahahaha!"

Bowser started to stuff his face. A _lot._

Peach sighed. She was a bit peckish, went for a few pieces of ham, and… no vegetables. Well, it _was_ Bowser's castle. At least he had cake.

By the time she'd finished her ham and had gotten to dessert, only one cake was left untouched. The King Koopa had ravaged the entire table! Peach hadn't thought anything of it, she couldn't imagine how tiring it was to fight the Mario Brothers, or if Bowser'd even had any breakfast for that matter. As the Shy Guys cleaned up and the Paratroopas hiked her off to the dungeon, she noticed more bottles all over the floor.

She eventually asked one of the two Koopatrol by her cage.

"I dunno. The boss's been weirdly thirsty lately. The air isn't any drier than usual, but he does tend to eat a lot more lately. Maybe it's all the extra salt from those drumsticks he likes so much? I'm no nutritionist, but that many chicken legs can't be healthy. What do you think, Yunn?"

Peach and the first Koopatrol turned to the other.

"Have you noticed he's been a lot easier to annoy lately? We've gotta be on our best behavior, Minn. Sorry Peach. You're gonna be stuck 'til the Bros. show up. If they even do! Hehehe..."

The two Koopatrol hi-fived each other… and the Bros. already arrived?!

There was the sound of fighting in the other room, and in ran Mario and Luigi. Minn and Yunn ran for the hills, and subsequently ran out a window a la Wile E. Coyote.

"Guh… wuh… graagh…. No fair!"

Bowser shouted from the other room before grunting and laying on the floor, K.O.'d.

"Peach! You're-a alright!"

Mario said, with a hop.

"Did Bowser even-a try this time?"

Luigi added.

"That was certainly quick of you two," Peach remarked. "I hope he's okay enough for the Lightning Cup races on Saturday..."

* * *

It came time for everyone to start their Karts or Bikes on Tick Tock Clock. Bowser was sitting in a Kart, since he'd fallen off his Bike in a few previous races… right around when he'd started to be really weirdly thirsty. Maybe he could chuck bottles instead of banana peels to slip everyone up? He didn't think much past that, but he wondered if it was foggy around the clock. The whole place was really blurry! He couldn't count how many times he accidentally rammed into a wall and sent coins flying.

Last place… He grumbled as they went to the next track, the Piranha Plant Slide. Again he saw funny, and everything was blurry… He hoped his vision wasn't getting worse, he'd just gotten new glasses…

Slip, slide… The Lakitu who had to keep setting him back on track brought him to a pitstop near the finish line after the fifth time.

"Are you doing okay, Bowser...?"  
"I'm FINE! I think my stupid Kart is broken!"

"It can't be broken! We just built it!"

"Well SOMETHING'S wrong with it! I finished in last place last race and I'll finish in last this one too 'cause you got me all stopped up here!"

Bowser was already fuming. The Lakitu stopped and looked at him a little funny…

"...Has your shell always been that big…?"

"What?"

"Your shell looks a little loose…"

"You're seeing stuff, dummy!"

"Come to think of it, your arms look a little stickly. You look like you've not slept too good. Are you sure you're doing okay? You've got a ton of empty water bottles in your Kart, too."

"Why's everyone bugging me about the bottles?! I'm just thirsty, that's all! A Koopa needs his water!"

"Bowser…. One bottle before a race is one thing, but _twelve?"_

The Lakitu floated a bit upwards

"So WHAT? I'm THIRSTY…. Again..."  
Bowser pulled another bottle out of his shell and sucked it down in seconds.

"Dude, I don't think that's normal,"

Said a Koopa driving by, finishing their final lap and pulling into the pit stop, only to speed back off as Bowser chucked the empty bottle at them.

The Lakitu stayed with Bowser while another Lakitu took his signage as a replacement.

"We don't want you to get too hurt while racing. We're going to take you to a doctor just to make sure you're alright and you're not coming down with something nasty, okay? A king's gotta be in good shape, you know?"

* * *

After the cup was over, everyone wondered where Bowser was. He was sitting, pouting angrily in the locker room, a charging Switch and folded glasses sitting next to him, amongst a mountain of snack wrappers. If he couldn't race in real life, he could at least play a game, right? He still lost. Everything was still slightly blurry to him, and his glasses didn't make a difference.

"It's not fair! My vision's all blurry, I can't see anything!"

He wailed as Mario and Luigi came in to pick up their stuff.

The Lakitu floated in to check in on everyone.

"We're getting you to a doc, Bowser. Do you want anyone with you?"  
"I'll-a go with you, Bowser."  
"NO! I don't want Mario there! I don't... want to go to the doctor's... either. I'm fine..."

Bowser let out a huge yawn and reached for another water bottle.

The group walked back out of the racing area and to go home, and Peach caught up with Bowser.

"Lakitu is right, you know. You've been acting strange lately, and that's a lot of water, even for a Koopa your size."

"...I'll go if you think I should."

Lakitu totally didn't tell Peach to go talk to Bowser to convince him to go.

"I'll go with you if it makes you feel better."

"...Let's get it over with."

Mario and Luigi went along, just to make sure Bowser didn't try to kidnap the Princess yet again. Once back in Toad Town, Dr. Toad had Bowser sit in his examination room as he checked his eyes, ears, throat, and the like.

"Can you tell me how you've been feeling lately?"

The Toad looked over a few pictures of Bowser from a few months ago; he'd definitely lost weight… but not in a flattering way.

"I've been really hungry and thirsty and stuff. Plus I can't really see… My glasses don't help at all! Grrrrrraaaaaaaugh!"

"He's also a lot easier to annoy,"

Added the Lakitu with him and Peach.

"Hm… Hrrm,"

Dr. Toad said, scribbling on a piece of paper.

"Do you notice you're using the bathroom a lot more often?"

"Yeah… It's weird. I'll have to get up four or more times in a sitting of Go Fish with Junior… when usually I'll never have to get up at all!"

Dr. Toad inhaled sharply.

"You may not like what I have to say next. We'll have to do a blood test. It won't hurt, but I do need to go fetch a nurse. I'll be right back."

"...Do you think it's bad, Peach? What if I can't kidnap you anymore?!"

Bowser looked ready to cry.  
"Fine by a-me,"

Luigi shrugged.  
"..."

"..."

Awkward silence hung in the room until a Koopa with a red shell and a labcoat came in, her hair pulled back into a ponytail.

"Hey there, I'm Nurse Koopetta! Can I see your hand, Bowser?"

He reluctantly held his hand out. She swabbed a finger to sterilize it and poked him with a little plastic pricker.

"YEOWCH!"

Bowser shouted, startled.

Before he could start freaking out, Koopetta put the blood on a little stick in a roundish flat machine… and her ponytail defied gravity when she read the number.

"NINE HUNDRED NINETY NINE—"  
The little machine let out a flat _BEEEEP _as it encountered an overflow of some kind.

"...Bowser, you're going to have to get used to needles…."

"Wuh?"

"Y'see…. Dr. Toad described your symptoms to me and they're all a big classic case of type one diabetes."

"I DON'T WANNA DIE FROM BEETS!"

Nurse Koopetta stifled a laugh.

"Don't worry, they're not going to hurt you. It doesn't have anything to do with beets. For a koopa your size, a little meter like that should usually read anywhere from 70 to 250. You're over 1,000. That's really bad, and it's why you've been drinking and eating so much! It's also why your vision's messed up."

"Gwaaaaaah! How do I fix it!? I don't want messed up eyes forever!"

"I'm afraid to say your body can't fix it on its own—"  
"DID THAT LITTLE GREEN FREAK DO SOMETHING TO ME?! I'LL BREAK HIS FACE!"

"I'm not sure if Fawful had a hand in this or not, but your body can't make insulin anymore. It's a hormone made by your pancreas that lets energy into your cells. Think of your pancreas like a Bullet Bill cannon! A regular one shoots regular Bullet Bills. Your cannon, however, can't fire anything! You've got type one diabetes. Type two, on the other hand, would be a Bullet Bill cannon that only fired… saaaay…. Goombas."

"Who broke my energy Bullet Bill pants grease cannon!?"

"Well… maybe you did? Not actually you, but some of the other cells in your body mistook the ones that make insulin for invaders so they beat them all up trying to keep you safe."

"GWAAAAGH, I'VE EVEN GOT INCOMPETENT MINIONS INSIDE OF ME!"

Bowser pulled on his hair and stomped his feet.

"It's okay to be mad,"

Nurse Koopetta said.

"It's hard! Chronic illness isn't easy, especially when you're used to not having to put up with it. By the way, like said earlier… you're going to have to get cool around needles more often. You'll need to inject insulin your body can't make. It's too complex and precise of a molecule to be able to deliver in a pill form..."

Dr. Toad pulled up a little chart of Bowser he'd drawn, with black shapes on his arms, soft tummy, upper tail, and thighs.

"Here are all the spots you can inject insulin. Like we're going to do now. Give it a little time to work, and we'll test again. You'll have to stay overnight for us to monitor you and hope you don't go low. Plus, it'll give you time to learn and practice important stuff."

"Okay, just be quick about it!"

Bowser snapped.

He held out one of his arms, as Dr. Toad pinched up some skin and injected the medicine. Bowser squeezed his eyes shut until Dr. Toad was done.

"We're-a here for you,"  
Mario said, looking at the glum Koopa King. None of the gang quite understood what was going on, but they'd all try their best to learn.

Insulin? Glucose? Carbs? Sugar? Dosing? Shots? Basal? They'd all come to learn what it meant, eventually.

Two hours after the first injection, Nurse Koopetta came back again and showed Bowser and friends how to use the blood glucose meter.

"It's easy. First, take one of these little strips," She opened the bottle of them and put it in the slot on the little machine. "Then, you put it in the slot. Next, you have to stick yourself with this pricker. You have to change the lancet inside once a day, but you can go a little longer if you're out of them. It hurts less the more you change them! Once you're all poked and blood's coming out, just put a droplet on the stick," She guided Bowser's hand. "And wait a few seconds…. Presto! There's your blood sugar! Looks like the insulin worked. You're still kind of high at 536, but it's a looooot better than over a thousand. Your target range is 70 to 250."

"Koopetta, what do those numbers mean? What do you mean by high?"

Peach asked.

"It's how much sugar is in Bowser's blood. When you eat food, your body breaks it down into all its good nutrients and stuff. Glucose is a sugar usually found in breads and sweets and a few other things. Bowser, you'll need to learn how to count carbs for what you eat. Anyway, a "high" is a case of hyperglycemia: too much glucose in the blood. This is countered with insulin. The inverse is hypoglycemia, or too little glucose in the blood. This is countered by eating food or having a sweet drink to bring yourself back up to speed."

"...Does this mean I can't have cake anymore?"

Bowser was startled again, ready to cry.

"Not at all! A lot of people start out thinking they can't have sugar, but you can, as long as you know how to bolus for it."

"What's bowl-us-ing?"

Asked Bowser.

"It's how you take enough insulin to work for food. Say you want to eat an apple. That has 15 carbs. You have a carb ratio of, say, 1 unit per 15 carbs. You would bolus 1 unit."

Replied Koopetta.

"Eeeeugh! That's a lot of math…. A king doesn't have time for that!"

"You seem like you might work better on a pump, then. It takes care of all the math for you, and can even automatically receive blood sugars from your meter."

"Gimme one!"

"They cost a pretty coin, though. You can work out a payment plan, though."  
"How much?"  
"They cost upwards of four thousand coins—"  
"Four thousand?! That's nothing for a king! I've shelled out 20,000 to get my shell a super spa treatment before! Felt good as a new Koopa! Bwahahahaha!"

"You have to pay for your medicine and other supplies, too. In Toad Town we recommend either Toadcom or Koopatronic."

"I raid castles real often, buddy! Pfft, I can handle it."

* * *

_Three, two, one, BEEP! 178!_

"Hey, it worked! Gwahahahaha! I'm in range! That's a good number, right?"

"Yep! It's under 250 and it's above 70. It's hard to keep it in range. Great job, Bowser!"

Dr. Toad was doing some math for Nurse Koopetta. That many units of insulin to a blood sugar of that number means Bowser's basal rate would be so-and-so…

"You guys got anything to eat? I'm getting hungry."

"Oooh, now would be a great time to figure out if your carb ratio is right."

"Carb ratio?"

"Yeah! We picked out a chicken salad sandwich, some chips, and a glass of milk. The sandwich is 30 carbs because of the bread, the chips are 15 carbs, and the milk is 15 carbs. Your whole meal is 60 carbs. That's a fairly average amount for a meal."

"How do I find out the carbs on food?"

"If it's got a package, flip it the other way to look at the nutrition label. It will have the amount of carbs per serving."

Nurse Koopetta picked up the carton of milk before letting Bowser pour it into the cup.

"See? On the back it says: serving size, one carton. This carton is a cup, or 8 ounces. One serving of this milk is 15 carbs. Pretty much every food is like that. For sandwiches, look at the carbs on the bread, and any spreads you use. Most sandwich spreads are fairly low in carbs that they can be considered 'free', but it's always good to check."

"Great! I'll be good as new soon! Right?"

"...That's the thing. Diabetes is chronic, Bowser. It doesn't go away… That's why we've gotta teach you all this stuff. Don't worry if you forget: we have these super helpful booklets!"

"Never…. Goes… away…"

"Like I said earlier: it's okay to be upset. Life's not fair, and it really stinks it happened to you, but you've gotta make the best of it. See, you're still the Koopa King, even with diabetes! It doesn't change who you are, you've just gotta live with it. You'll want to take it easy for a little bit while you're learning to take care of yourself, though. Then once you're confident you can do everything on your own, you can jump right back into taking over the Mushroom Kingdom or beating up evil bean people."

"..."

"...Bowser?"

"...I'm fine. What's all that about a ratio?"

"Okay! Your lunch is 60 carbs. You bolus 1 unit for every 10 carbs. How many units do you need to take?"  
"Six?"  
"Perfect!"  
"Yech, am I going to have to do math every time I eat!?"  
"Yep. But not as much if you go on a pump."

"...I like the sound of Koopatronic. Sounds cooler than Toadcom."

"Sure thing. What color do you want your pump to be? They offer them in all kinds."

"RED! No, BLACK! Yeah, black."

"Gotcha."

"...Oh man. I still gotta get a shot, don't I..."

"Yep. Six units, coming up."

"YEOWCH!"

"..."

"...Gimme my lunch, I'm starving."

* * *

"With a pump, you won't need to inject as much, but you'll have to wear it all the time. It's better than lugging around a little ice pack and a bunch of needles and a log book!"

The big old Koopa finished the last bites of his sandwich.

"Yeah! Thanks, Koopetta! Gwahahaha! That was the best sandwich I've had in a while..."

A new Koopa had come in, this time with an orange shell and a bow on the back of her head. She had glasses and a sweater on, but no lab coat.

"I'm Tori Koopa, I'll be your Koopatronic representative, Your Spinyness."

Tori let him examine the pump. Bowser held the device in his hand. It was blocky and had a little colorful screen on it that told the time, how much insulin he had left in his pump, connectivity to his continuous glucose monitor, and its battery level.

"So this little white monitory thing on my arm will help me keep an eye out on my blood sugar?"

Bowser turned his head to stare at it with curiosity.

"Yep! It keeps track of your blood sugar and sends it to your pump every five minutes, keeping it super up to date. You'll still have to manually check three to four times a day, preferably before meals, and don't calibrate when there's more than one arrow on the screen pointing up or down. It'll also warn you if you're going high or low."

Tori pointed out the little icons on the screen. His sensor was warming up and wouldn't be ready for two hours yet.

"While we wait, let's punch in your basal rate."

"What's my basal again…?"

"You see, Bowser, your **basal rate **is the **base amount of insulin **you receive in a day, excluding anything extra for food."

Tori explained, reading off the calculated times and numbers for his first basal rate.

"Then what's my carb ratio again?"

"Your **carb ratio **is the **number of carbs per unit of insulin you take.** Try to take it around 15 minutes before eating."

A few other settings were set to go and Bowser looked over his pump.

"Great! Now how do I make it work?"

"You'll have to wear a pump site; it's kinda like a mini-IV."  
"..."

"They don't hurt very much, if at all. You're a big tough Koopa, needles are a breeze for you, since you're so tough against those Mario Bros., too."

"Yeah! I can do it, no needle's gonna hurt The Bowser!"

* * *

"This set is what I'd recommend for a fella like you. It's the K-Sure, with one circle with the cannula that goes under the skin, and the other being an anchor to stop it from getting pulled out if you catch your tubing on something or drop your pump."

Tori let him open a set or two to practice.

"You can-a try it on-a-me, Bowser. We didn't-a-know you weren't-a feeling well on Monday."

Mario rolled up his sleeve and offered his arm, but Tori had him practice with one set first on an orange.

"Gently pinch and insert. There you go, Bowser! You're a natural! Are you ready to try it on Mario?"

"Gwahahaha, I get to stab my rival? Of course!"

He followed Tori's instructions again, gently pressing the site into Mario's arm. Luigi covered his eyes.

"Mamma-mia! That didn't-a hurt at all!"

Mario smiled at Bowser and gave him a gentle pat on his shell.

"Luigi and I can try to-a help if it gets-a-tough, okay?"

"T-thanks, Mario…"

Bowser started to follow more of Tori's instructions.

He picked up the bottle of insulin and stuck it to a **reservoir. **He used the plunger on the reservoir to draw insulin into it until it was to the 200U mark, which was 2mL of insulin. Next, Tori had him remove the plunger, and put on the **tubing. **The plastic tubing was medical grade tubing, which connected the pump's insulin reservoir to the **cannula **inside the pump site. The **cannula **goes under the skin to deliver insulin into the body. Bowser had to **prime **the pump first, allowing it to fill the tubing and cannula with insulin.

"Air bubbles can be dangerous; they'll take the place of insulin and cause you to go high, and you'll be none the wiser until you get a high alert even though you know you bolused!"

Tori added, making sure insulin dripped out.

Lastly, she had Bowser disconnect the part of tubing that went on him. She showed Bowser how to remove the little plastic cap over the needlelike cannula, and how to peel back the paper.

"Just like you did on Mario, pinch your skin…"

Bowser pinched a spot on his belly.

"Then push the site in with care not to hurt yourself or damage the site."

In a few seconds, Bowser put in his site with no troubles, sticking it to his belly and sticking on the second part to help keep the site from falling off. He clicked his tubing back together and put his pump in a pack he decided to keep around his leg. It was plain black, to keep with the rest of his aesthetic.

"Great job, Bowser! You're doing so well! We're all really proud of you. It's hard enough for anyone to get diagnosed, and it's gotta be tough for a big guy like you to take a knock, but you're already on your way to being able to do what you want again!"

Koopette hopped in place, excited.

"Let's check your blood."

Bowser was immediately on it. Click, 1, 2, 3, BEEP! 119.

"Gwahahaha! It's still good! And I'm hungry again."

"Awesome, let's try out your pump! For an easy example for reading off a box, we found a microwave dinner that's steak, mushrooms, and mashed potato. Read the carbs."

"It's got fourty-five carbs for the whole thing. Fourty-five—WOAH! My eyes are working again! Nice!"

"Punch it into your pump. Use the bolus wizard."

The pump's background changed to a Magikoopa with text overlaid.

"Aw, this thing is SWEET!"

Bowser laughed.

"Fourty five carbs… blood sugar's 119…"

"4.5 units. Send it?"

"Yep!"

Bowser microwaved his dinner and relished in delight as he ate it and started to let his new life sink in as he sat in bed. They had to do overnight monitoring, and everyone else had to go. Peach had to go home, Lakitu had to go home, and Luigi started to scram, but Mario stayed the night with Bowser.

He knew how scary it was to be in a hospital, and it was doubly scary overnight. He couldn't imagine how scared the big ol' Koopa might be, being away from his castle and being newly diagnosed with some complicated chronic illness. He called up to have Junior come.

Mario couldn't believe the little guy was still up!

"It's a-me, Mario,"

He said, on the phone.

"Your-a old man is in the hospital. He'd like it a lot if you could come and keep him a-company."

"Is he okay!? What'd you do to him!?"

"No, no, no, he's a-okay. We-a found out why he was-a so thirsty all the time!"

"What's wrong where he's gotta go overnight?"

"It's-a lot to-a explain. I can say more in-a person. Bring-a your homework if you-a have any, I can help you while we-a talk."

* * *

Bowser Jr. walked in and Mario led him to where Bowser was, laying in bed about ready to snooze before sitting up to check his blood again.

"Hey dad! Are you okay!?"

"Junior! Mario, did you….?"

The plumber gave Bowser a nod.

"Heya, kiddo."

"Are you okay, dad?"  
"Well, kind of. I'm sick, but I can't give it to you. You're okay to sit on my lap. Check it out."

He pulled down the blanket to show Jr. the pump site.

"Part of my guts got all messed up by accident, so I have to wear this device and take medicine so I can eat and stuff."

"Does it hurt?"  
"Not at all, squirt. I just gotta punch in numbers to stay healthy when I eat and do stuff. It was really nice of you to come by and visit. I gotta stay overnight."

"It was Mario's idea! And he's gonna help me with my math homework!"

Bowser looked up and Mario gave another nod.

"I figured it would be a little bit less-a lonely if he was-a here with his old man to learn what's-a going on."

"C'mon, Mario, I gotta figure this multiplicatey thing out."

"Let's a-do-it."

They sat at the table in the overnight room, opening Jr's textbook, and chatting away about multiplication and times tables and ways to remember what different numbers did.

"Junior, you-a see, your dad's got-a condition called-a diabetes. His body can't-a make insulin anymore, so he's got to-a monitor his blood sugars on-a his own, and give-a himself enough insulin to be able to-a function and eat."

"That sounds kinda scary. Will he get better…?"  
"I'm-a afraid not, the doctors-a said it's chronic. But-a you can help him! When-a you have food, ask-a the chefs what they think the proper carbs would-a be. That-a-way, he can dose right for what you'll-a all eat, and-a he'll be right in-a range!"

"Range?"  
"If-a his blood sugar goes under 70, or over 250, that's-a out of range, and has to get-a fixed! Else he won't-a feel too good."

"That stinks! I wanna help him not feel bad! I'll help him do that carb county thing you said!"

Bowser started to drift off, smiling softly as he watched his rival and his son have a sweet, wholesome interaction. The big ol' Koopa was definitely going to need all the help he could get managing his new condition.

King, Dad, and now, diabetic.

He wondered what the next day would bring.


End file.
